2 research outputs found
COvid MEdicaTion (COMET) study: protocol for a cohort study
Various theories about drugs such as ACE inhibitors or
angiotensin II receptor blockers (ARBs) in relation to
severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and clinical outcomes of COVID-19 are circulating
in both mainstream media and medical literature.
These are based on the fact that ACE2 facilitates SARSCoV-2 cell invasion via binding of a viral spike protein
to ACE2. However, the effect of ACE inhibitors, ARBs
and other drugs on ACE2 is unclear and all theories
are based on conflicting evidence mainly from animal
studies. Therefore, clinical evidence is urgently needed.
The aim of this study is to investigate the relationship
between use of these drugs on clinical outcome of
patients with COVID-19. Patients will be included from
several hospitals in Europe. Data will be collected in a
user-friendly database (Digitalis) on an external server.
Analyses will be adjusted for sex, age and presence of
cardiovascular disease, hypertension and diabetes. These
results will enable more rational choices for randomised
controlled trials for preventive and therapeutic strategies
in COVID-19
No association between use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers prior to hospital admission and clinical course of COVID-19 in the COvid MEdicaTion (COMET) study
Since the outbreak of SARS-CoV-2, also known as COVID-19, conflicting theories have circulated on the influence of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) on incidence and clinical course of COVID-19, but data are scarce. The COvid MEdicaTion (COMET) study is an observational, multinational study that focused on the clinical course of COVID-19 (i.e. hospital mortality and intensive care unit [ICU] admission), and included COVID-19 patients who were registered at the emergency department or admitted to clinical wards of 63 participating hospitals. Pharmacists, clinical pharmacologists or treating physicians collected data on medication prescribed prior to admission. The association between the medication and composite clinical endpoint, including mortality and ICU admission, was analysed by multivariable logistic regression models to adjust for potential confounders. A total of 4870 patients were enrolled. ACEi were used by 847 (17.4%) patients and ARB by 761 (15.6%) patients. No significant association was seen with ACEi and the composite endpoint (adjusted odds ratio [OR] 0.94; 95% confidence interval [CI] 0.79 to 1.12), mortality (OR 1.03; 95%CI 0.84 to 1.27) or ICU admission (OR 0.96; 95%CI 0.78 to 1.19) after adjustment for covariates. Similarly, no association was observed between ARB and the composite endpoint (OR 1.09; 95%CI 0.90 to 1.30), mortality (OR 1.12; OR 0.90 to 1.39) or ICU admission (OR 1.21; 95%CI 0.98 to 1.49). In conclusion, we found no evidence of a harmful or beneficial effect of ACEi or ARB use prior to hospital admission on ICU admission or hospital mortality